October 26

Bush Plans to Screen Whole US Population for Mental Illness – BMJ

Bush Plans to Screen Whole US Population for Mental Illness – BMJ

Thu, 24 Jun 2004

A second article in the British Medical Journal discloses additional evidence uncovered by Allen Jones, the whistle blower from the Pennsylvania Inspector General’s Office. The first BMJ article focused on the Texas Medication Algorithm Project (TMAP)–which was developed by University of Texas psychiatrists, paid for by Big Pharma, and adopted during the Bush governorship. See: Whistleblower removed from job for talking to the press by Jeanne Lenzer
BMJ 2004;328:1153 (15 May), doi:10.1136/bmj.328.7449.1153

The documents uncovered by Jones show that TMAP is the biggest pharmaceutical / state mental health marketing rip off scheme masquerading as “evidence-based” treatment guidelines. (See Allen Jones report: http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf )

The current BMJ article focuses on documents that expose an even more ambitious “mental health” initiative–a nationwide screening for “mental illness” campaign that is about to be unleashed on the American public in July. This dubious, government sponsored initiative, will implement the TMAP formula nationally. The first target population for this massive screening for mental illness initiative is in America’s schools: 52 million American school children and 6 million school personnel are about to be ordered to undergo screening tests for hidden mental illnesses–as if mental illness needs to be ferreted out and captured like a rabid animal.

This massive screening initiative was formulated by President Bush’s New Freedom Commission on Mental Health (2002). It is the culmination of a series of dubious federally sponsored, “mental health” initiatives–begun during the Clinton Administration–that focus especially on children. See: U.S. Surgeon General. Report of the Surgeon General’s Conference on Children’s Mental Health: National Action Agenda. January 3, 2001.

These “mental health” initiatives have methodically inflated the number of American children (and adults) being labeled with a mental illness; they have inflated the number of dependents with “mental illness” on social security disability (SSDI & SSI); and they have led to the depletion of public and private health insurance budgets because of disproportionate skyrocketing expenditure for the most expensive psychotropic drugs–even as scientific evidence is lacking to demonstrate the benefit of these drugs.

Robert Whitaker, author of the prize winning book, Mad in America, that laid bare the mistreatment of patients with schizophrenia, and the unprecedented profitable marketing of the atypical anti-psychotic drugs, has recently gathered the following data from government sources about the extraordinary increase in use of these drugs and the cost to taxpayers. He chose 1987 as the benchmark date because the following year Prozac-the first of the new generation of “wonder drugs”–was introduced.

Social Security Disability Payments (SSDI)

In 1987, 875,000 people received SSDI payments because of mental illness.

By 2002, that number had grown to 1.7 million people who received SSDI because of mental illness. That an increase of 825,000 people over 15 years, or about 55,000 people per year.


In 1987, 2.63 million people received SSI payments because of a mental disorder.

In 2002, 4.07 million received SSI because they had a diagnosable mental disorder.

Thus, the number of people with a mental disorder receiving SSI grew 1.44 million people over this 15-year period, or about 95,000 people per year.


In 1987 the number of people receiving SSI or SSDI payments because of mental disorders was 3.505 million.

In 2002, the number receiving SSI or SSDI payments was 5.77 million.

That’s an increase of 2.265 million people in the past 15 years, or about 150,000 people per year.


In 1987, psychotropic drug expenditure was $1 billion.

By 2002, it was $23 billion–23 times the amount spent 15 years earlier.

Screening for mental illness serves no useful medical or societal purpose inasmuch as there are no reliable diagnostic tools for mental illness, and no proven safe and effective treatments. Clinical trial data from SSRI antidepressants and so-called atypical anti-psychotics failed to demonstrate either these drugs’ safety or a benefit greater than placebo. But, as Allen Jones’ documents make clear, the TMAP practice guidelines designate these very drugs as the treatment of choice–not on the basis of evidence, but on the basis of a consensus panel. A panel under the direct influence of Big Pharma.

Indeed, as the BMJ reports, "Dr Peter J Weiden, who was a member of the [TMAP] project’s expert consensus panel, charges that the guidelines are based on “opinions, not data” and that bias due to funding sources undermines the credibility of the guidelines since “most of the guideline’s authors have received support from the pharmaceutical industry.” ( BMJ 2004;328:1153 )


If implemented, this “new freedom” initiative establishes a coercive selection policy that opens the door to discrimination and forced treatment with powerful, psychotropic drugs that have caused more harm to children (and adults) than the conditions for which they were prescribed. Children and adults who will be labeled mentally ill on the basis of unreliable, subjective tests (essentially questionnaires), can expect to lose their autonomy as a brigade of mental health providers intrudes on their lives and takes over their decision-making authority. Those labeled mentally ill can expect to be stripped of their civil and human rights.

Already, a surgically implanted psychotropic drug dispenser–to assure compliance with prescribed drug regimens–is under development in clinical trials at the University of Pennsylvania. See: https://ahrp.org/infomail/03/10/07.php and ethics debate

We don’t have policies to screen innocent people for crimes they have not committed on the theory that early intervention is a justifiable crime prevention measure. We don’t have screening policies to ferret out would-be terrorists. What possible justification does the government have to put children through a dubious screening process for suspected mental illness?

This involuntary, pseudo-medical government sponsored selection policy is a chilling example of the illegitimate intrusion by government into personal, and confidential healthcare decisions.

The public needs to be ever vigilant against such overreaching government policies which have historically proven harmful. Being labeled “mentally ill” and being forced to ingest psychotropic drugs whose harmful effects are only beginning to be disclosed–is not in the best interest of children.

An examination of Germany’s mental and racial “hygiene” policies and the implementation of those policies, before the Holocaust, is a sobering awakening. German children were screened and tested for disabilities (“deformities”), then removed from their families, institutionalized, and eventually gassed by Nazi doctors–many of whom were prominent psychiatrists.

See, Hitler’s Unwanted Children: Children with Disabilities, Orphans, Juvenile Delinquents and Non-Conformist Young People In Nazi Germany (1998), by AHRP board member, Dr. Sally Rogow. http://www.nizkor.org/ftp.cgi/people/r/rogow.sally/hitlers-unwanted-children

Contact: Vera Hassner Sharav
Tel: 212-595-8974


Bush Plans to Screen Whole US Population for Mental Illness
by Jeanne Lenzer –
BMJ 2004;328:1458 (19 June)

A sweeping mental health initiative will be unveiled by President eorge W Bush in July. The plan promises to integrate mentally ill patients fully into the community by providing “services in the community, rather than institutions,” according to a March 2004 progress report entitled New Freedom Initiative (www.whitehouse.gov/infocus/newfreedom/toc-2004.html). While some praise the plan’s goals, others say it protects the profits of drug companies at the expense of the public.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a “comprehensive study of the United States mental health service delivery system.” The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

The president’s commission found that “despite their prevalence, mental disorders often go undiagnosed” and recommended comprehensive mental health screening for “consumers of all ages,” including preschool children. According to the commission, “Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders.” Schools, wrote the commission, are in a “key position” to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended “Linkage [of screening] with treatment and supports” including “state-of-the-art treatments” using “specific medications for specific conditions.” The commission commended the Texas Medication Algorithm Project (TMAP) as a “model” medication treatment plan that “illustrates an evidence-based practice that results in better consumer outcomes.”

Dr Darrel Regier, director of research at the American Psychiatric Association (APA), lauded the president’s initiative and the Texas project model saying, “What’s nice about TMAP is that this is a logical plan based on efficacy data from clinical trials.”

He said the association has called for increased funding for implementation of the overall plan. But the Texas project, which promotes the use of newer, more expensive antidepressants and antipsychotic drugs, sparked off controversy when Allen Jones, an employee of the Pennsylvania Office of the Inspector General, revealed that key officials with influence over the medication plan in his state received money and perks from drug companies with a stake in the medication algorithm (15 May, p1153 http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7449/1153 ). He was sacked this week for speaking to the BMJ and the New York Times.

The Texas project started in 1995 as an alliance of individuals from the pharmaceutical industry, the University of Texas, and the mental health and corrections systems of Texas. The project was funded by a Robert Wood Johnson grant and by several drug companies. Mr. Jones told the BMJ that the same “political/pharmaceutical alliance” that generated the Texas project was behind the recommendations of the New Freedom Commission, which, according to his whistleblower report, were “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab” (http://psychrights.org/Drugs/AllenJonesTMAPJanuary20.pdf ).

Larry D Sasich, research associate with Public Citizen in Washington, DC, told the BMJ that studies in both the United States and Great Britain suggest that “using the older drugs first makes sense. There’s nothing in the labeling of the newer atypical antipsychotic drugs that suggests they are superior in efficacy to haloperidol [an older, {far cheaper} “typical” antipsychotic]. There has to be an enormous amount of unnecessary expenditures for the newer drugs.”

[Drug companies have contributed three times more to the campaign of George W. Bush, seen here campaigning in Florida, than to that of his rival John Kerry]

Olanzapine (trade name Zyprexa), one of the atypical antipsychotic drugs recommended as a first line drug in the Texas algorithm, grossed $4.28bn (£2.35bn; 3.56bn) worldwide in 2003 and is Eli Lilly’s top selling drug. A 2003 New York Times article by Gardiner Harris reported that 70% of olanzapine sales are paid for by government agencies, such as Medicare and Medicaid.

Eli Lilly, manufacturer of olanzapine, has multiple ties to the Bush administration. George Bush Sr was a member of Lilly’s board of directors and Bush Jr. appointed Lilly’s chief executive officer, Sidney Taurel, to a seat on the Homeland Security Council. Lilly made $1.6m in political contributions in 2000<82% of which went to Bush and the Republican Party.

Jones points out that the companies that helped to start up the Texas project have been, and still are, big contributors to the election funds of George W Bush. In addition, some members of the New Freedom Commission have served on advisory boards for these same companies, while others have direct ties to the Texas Medication Algorithm Project.

Bush was the governor of Texas during the development of the Texas project, and, during his 2000 presidential campaign, he boasted of his support for the project and the fact that the legislation he passed expanded Medicaid coverage of psychotropic drugs.

Bush is the clear front-runner when it comes to drug company contributions. According to the Center for Responsive Politics (CRP), manufacturers of drugs and health products have contributed $764,274 to the 2004 Bush campaign through their political action committees and employees, far outstripping the $149 400 given to his chief rival, John Kerry, by 26 April.

Drug companies have fared exceedingly well under the Bush administration, according to the centre’s spokesperson, Steven Weiss. The commission’s recommendation for increased screening has also been questioned. Robert Whitaker, journalist and author of Mad in America, says that while increased screening “may seem defensible,” it could also be seen as “fishing for customers,” and that exorbitant spending on new drugs “robs from other forms of care such as job training and shelter programmes.”

But Dr Graham Emslie, who helped develop the Texas project, defends screening: “There are good data showing that if you identify kids at an earlier age who are aggressive, you can intervene… and change their trajectory.”

Rapid Responses:
Read all Rapid Responses

Other related articles in BMJ:
BMJ 2004;328:1153 (15 May), doi:10.1136/bmj.328.7449.1153
Whistleblower removed from job for talking to the press by Jeanne Lenzer

New York A whistleblower who uncovered evidence that major drug companies sought to influence government officials has been removed from his job and placed on administrative leave. Allen Jones, an investigator at the Pennsylvania Office of the Inspector General (OIG), was escorted out of his workplace on 28 April and told “not to appear on OIG property” after OIG officials accused him of talking to the press. Reports of Mr Jones’s findings were widely reported in the New York Times, BMJ (7 February, p 306), and elsewhere. His findings showed that the pharmaceutical company Janssen had paid honorariums to key state officials who held influence over the drugs prescribed in state-run prisons and mental hospitals.

Mr Jones filed a suit on 7 May against his supervisors charging that the OIG’s policy of barring employees from talking to the media was “unconstitutional.” Mr Jones claims, in the complaint filed in the Middle District Court of Pennsylvania, that he is being harassed by his superiors and Pennsylvania governmental institutions in order to “coverup, discourage, and limit any investigations or oversight into the corrupt practices of large drug companies and corrupt public officials who have acted with them.”

Mr Jones had been earlier removed as lead investigator on the case after being told by a manager that “drug companies write cheques to politicians on both sides of the aisle.”

In July 2002 Mr Jones was appointed lead investigator when he uncovered evidence of payments into an off-the-books account. The account, earmarked for “educational grants” was funded in large part by Pfizer and Janssen Pharmaceuticals. Payments were made from the account to state employees who developed formulary guidelines recommending expensive new drugs over older, cheaper drugs with proved track records.

One of the recommended drugs was Janssen’s antipsychotic medicine risperidone (Risperdal) – a drug that has recently been found to have potentially lethal side effects. The Food and Drug Administration issued a warning letter to Janssen on 27 April saying that Janssen’s “Dear Healthcare Provider” letter about risperidone was “false or misleading” because it failed to disclose or minimised risks of the drug relating to “serious adverse events including ketoacidosis, hyperosmolar coma, and death.”

Don Bailey, Mr Jones’s attorney, said the case is a critical test of the right to a free press. “If they shut the employee up and they have all the documents locked up in a drawer there is no free press,” he said.

Amy Wasserleben, spokeswoman for the OIG, said they would not comment on Mr Jones or the corruption allegations. When asked about the status of the corruption investigation she refused to answer. In response to a question about whether the state OIG could withhold information of public interest, she said, “The OIG is specifically exempt from right-to-know laws.”

The Pennsylvania formulary is based on the Texas Medication Algorithm Project that has been exported to about 12 states and was recently commended as a model programme by President Bush’s New Freedom Commission. However, Dr Peter J Weiden, who was a member of the project’s expert consensus panel, charges that the guidelines are based on “opinions, not data” and that bias due to funding sources undermines the credibility of the guidelines since “most of the guideline’s authors have received support from the pharmaceutical industry.”

Read all Rapid Responses

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